Healthcare Provider Details

I. General information

NPI: 1659702207
Provider Name (Legal Business Name): OFICINA MEDICO PRIMARIO DR. EDUARDO DIAZ CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CALLE MUNOZ RIVERA
CAYEY PR
00736
US

IV. Provider business mailing address

CALLE 4 E8 BONEVILLE TERRACE
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-263-0965
  • Fax: 787-735-7613
Mailing address:
  • Phone: 787-263-0965
  • Fax: 787-735-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO DIAZ
Title or Position: MD
Credential:
Phone: 787-263-0965